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Intake Form

This is our on-line intake form. Please answer the questions the best that you can. If you do not know the answer go ahead and fill out the form and we then will contact you for additional information.

Conditions MUST Be Met Before Any Notices Will Be Sent (except for ones forwarded from the National Center for Missing and Exploited Children (NCMEC))

All cases have to have been entered into the F.B.I.'s National Crime Information Center (NCIC).
We need permission from the custodial parent, guardian, and the Law Enforcement Agency handling the case permission to distribute the photograph of missing child.
We will not publish or distribute photographs of abductors unless a felony warrant has been issued for the abductor and we receive the permission from the Law Enforcement Agency that issued the warrant.

 

CONTACT INFO.

Your Name
Email Address:
Ph. Number: ()
Relationship to Child?:
Custodial Parent Name:
(If other than person filing out form)
Custodial Parent Email:
(If other than person filing out form)
Custodial Parent Ph. No.
(If other than person filing out form)

()

Secondary Contact
(In case we are unable to reach
Custodial Parent)

MISSING CHILD'S INFO.

Child's Name:
Date of Birth (DOB):
Date Missing: 

Missing From:

School, Park, Mall, Hhome...

City, State

 

,

Sex: Male Female
Height / Weight: Ht. ft. in. Wt. lbs.
Hair: Color: Style:
Eyes: Color: Glasses/Contacts:
Right/Left Handed? Right,   Left
Build: Small Medium Large
Scars / Birthmarks /
Tattoos / Piercings
Nick/Street Name(s)
Medical Notes
Clothes When Last Seen

CASE INFO.

Type of Case:
Law Enforcement Agency (LEA)
LEA Contact Ph
(Number for information)
()
LEA Off./Det. Name
LEA Report Ph.
Number to call with information)
()
Case Number LEA Case #: NCIC #:
Companion(s) Information
Suspect(s) Information
Abductor(s) Information
Witness Information
Notes or Additional Information

 

 

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